Review of services for people living with HIV in New Zealand

clinics are men). It is a specialist service for addressing these issues, offering a viable alternative toDHB primary care services. HIV is integrated into all aspects of FP’s work, for example by theprovision of HIV testing in clinics, as well as in the organisation’s education, health promotion,advocacy and professional development work. Emphasis is given to sexual and reproductive healthrights, and empowerment of women and girls in relation to these, including through HIV education.60 percent of FP’s health promotion activities target young people – through direct campaigns inschools, youth groups and outreach events, together with consultancy work in schools and theprovision of professional training, for example of teachers. FP’s adult health promotion oftenengages parents, making significant use of media, events and expos. FP has recently applied toprovide medical TOP services.Nationally, FP has 33 clinics, with 280 staff, 22 of whom are full‐time health promoters. 80 percent ofFP funding ($12–13 million) is from Government – approximately two‐thirds is for clinical work, andone‐third for health promotion. FP charges a co‐payment for some service‐users – services are freefor those under 22 years, $5 for Community Services Card holders and $22.50 for all others.Although FP offers diagnostic HIV testing as part of general STI screening in its clinics (and isparticipating in a pilot project on antenatal HIV screening in Hamilton), and promotes and distributescondoms as part of its general sexual health programme, it does not provide clinical care for PLHA;nor does it use rapid tests for HIV. When blood samples are taken for ‘conventional’ STI screening,clients are asked if they want to be tested for HIV also (the ‘opt‐in’ model); if they do, they are sent tohave their blood taken at the local laboratory. Occasionally, FP clinicians may refer a person to thelocal DHB SH service for T&C, though this is not the normal practice. Where people are found to haveHIV infection, they are referred to the local hospital ID department for clinical follow‐up.During 2008–2009, FP recorded 180,000 client visits to its clinics, 95 percent of which were byfemales. Approximately 50 percent of those attending were under 22 years, and the most commonlycited reason for attendance was ‘contraception’; STI testing/treatment was the second most‐citedreason, accounting for 17.4 percent of visits (see Figure 2). In the same period, FP reported 60,000health promotion contacts. According to FP data, ‘Maori make up around 14 per cent of our totalclient numbers, Pacific Island people 5 per cent, and Asian people around 5.6 per cent.’ The rest selfidentifiedas European. FP uses the Office of Ethnic Affairs’ Language Line translation service to assistclients who speak English as a second language: telephone translators protect client confidentiality(Family Planning 2009, p. 7). Given the pressure on services, clinic visits are much like those ofprimary medical care services – 10‐minute encounters are the norm.In discussing current gaps in services for PLHA in New Zealand, FP acknowledged that beyond thescope of services it provides, it could refer clients to further treatment and support services (albeitwith limitations in some geographical areas). However, it expressed a clinically based concern aboutthe lack of targeted and effective prevention for migrant communities, and for MSM.28 REVIEW OF SERVICES FOR PLHA